Origins of Evidence Based Practice and What it Means for Nurses by Emily J Brower MSN RN CEN and Rebbecca Nemec MSN RN Abstract Evidence based practice is a term used throughout multiple disci plines in healthcare to describe the use of research in clinical decision making However despite its frequent usage in healthcare vernacular there remains a gap between the understanding and ap plication of evidence based practice In an effort to assist in transforming evi dence based care from a buzz word into a guiding framework for clinical practice the origins evolution rationale and use of evidence based practice are explored and a case study is provided Keywords evidence based practice application to practice history Evidence based practice EBP is a term that has come into frequent use in healthcare It is the driving force for many quality improvement initiatives and the standardiza tion of healthcare practices and policies Stevens 2013 In addition an Institute of Medicine report encourages EBP by requiring 90 of clinical decisions by the year 2020 to be based on this approach Olsen Aisner McGinnis 2007 With such a robust goal it is imperative to have up to date knowledge regarding the implementation of EBP Even so confusion and uncertainty exists surrounding the concepts involved Melnyk 2012 In addition many healthcare pro fessionals are not clear on the meaning of EBP on a practi cal and personally applicable level and face barriers when attempting implementation Boswell Cannon 2017 p 42 Spruce 2014 This article aims to explicate EBP from the history of its origin to present day application The History of Evidence Based Practice In order to more fully understand EBP a brief review of its origins is helpful The initiation of EBP has been traced to the mid 1800s In the field of nursing Florence Nightingale has been credited with first evaluating and making decisions based on observed outcomes Mackey Bassendowski 2016 One example of Nightingale s work was the use of hot water and soap as the most effective way to cleanse skin in comparison with cold water with soap or cold water without soap Another Nightingale example was the consideration of age and sex into the treatment plan for patients She was surprised when physicians suggested a similar outcome for patients regardless of their demographics Mackey Bas sendowski 2016 Nightingale managed despite limitations to the body of knowledge at the time to make changes in an effort to improve patient outcomes Claude Bernade a physiologist in the 1800 s was another early proponent of using scientific evidence to support medical knowledge Keller 2012 Morabia 2006 Bernade aimed to advance medicine past its existing status as an art that was primarily directed by intuition Morabia 2006 Continuing into the 20th century the majority of medical decisions were based upon physician assessments and choices The realization that many physicians were practicing quite differently despite similar patient scenarios led to the next step in the develop ment of EBP Mackey Bassendowski 2016 Archibald Cochrane a Scottish physician was able to recognize the errors and lack of efficiency existing in medicine at the time The widespread use of controlled randomized trials and the effort to provide a more uniform approach to medical deci sion making began in the 1970s Evidence based medicine was formally introduced in a series of articles published by Cochrane in 1992 Keller 2012 These publications sparked an ongoing trend of defining implementing and improving what is now called Evidence Based Practice continued on next page 14 International Journal of Childbirth Education Volume 32 Number 2 April 2017 Origins of Evidence Based Practice continued from previous page The Evolution to a Current Definition of EBP With the basic constructs of EBP in place Dr David Sackett addressed skepticism surrounding the new ideas of research grounded healthcare and formalized the widely ac cepted definition of EBP Sackett Rosenberg Gray Haynes Richardson 1996 Keller 2012 Stevens 2013 Sackett et al 1996 stated that health professionals should apply the conscientious explicit and judicious use of current best evi dence in making decisions about the care of the individual patient It means integrating individual clinical expertise with the best available external clinical evidence from systematic research p 1 While this definition and concept may seem routine today at the time it was a revolutionary Sackett identified that experience from clinical expertise was of value if used concurrently with the best research This definition has since been expanded to include the addition of a third concept patient preference In 2000 Sackett and colleagues published an article defining a third concept acknowledg ing personal preference unique concerns expectations and values in a patient s care Sackett et al 2000 Thus EBP can be identified as a combination of three concepts clinical expertise best research and patient preferences Spruce 2015 Sackett et al 2000 The Expansion of EBP to Other Disciplines While EBP originated from the nursing and medical disciplines it has since expanded to many other professions including some outside of healthcare Rahman Apple baum 2010 In fact the field of education adopted the con struct of EBP as early as 1998 Biesta 2007 The specifics of EBP implementation differ for various disciplines yet the fo cus still revolves around practice guided by solidly grounded research Other disciplines that have sought research based quality improvement and thus EBP include physical therapy audiology speech language pathology dentistry social work and information science Hempenstall 2014 The use of EBP amongst multiple disciplines helps confirm its validity as well as expanding the potential for increased interdisci plinary collaboration Why is EBP Important There are many objectives motivating efforts to increase the implementation of EBP The Institute of Medicine IOM focuses on improving health care quality in order to increase positive outcomes through consistent use of research based knowledge The IOM has issued a challenge to change the way nursing is practiced by bridging the chasm between research knowledge and practice Stevens 2013 It has been established that if EBP can be implemented it will improve patient outcomes while decreasing patient care costs Spruce 2014 Melnyk 2012 Emparanza Cabella Burls 2015 EBP also allows for the standardization of care Spruce 2014